论文部分内容阅读
目的:探讨妊娠期高血压疾病（hypertensive disorders of pregnancy, HDP）对胎龄<32周的极早产儿住院期间死亡与主要并发症的影响。方法:本研究通过山东新生儿协作网，采用多中心前瞻性队列研究，纳入2018年1月1日至2019年12月31日在山东省多中心极低出生体重儿预后评估协作组中35家医院（包括26家综合医院、9家妇幼保健院）的新生儿重症监护病房收治的极早产儿。根据极早产儿母亲是否发生HDP，将所有研究对象分为HDP组和非HDP组。采用单因素n χ2检验、n t检验、秩和检验和多因素logistic回归模型分析HDP对其死亡及住院期间主要并发症的影响。n 结果:（1）研究期间，共纳入符合条件的极早产儿3 659例，其中男2 021例（55.2%），胎龄<28周的超早产儿434例（11.9%），超低出生体重儿433例（11.8%）；母亲HDP患病率为24.4%（892/3 659）。（2）与非HDP组相比，HDP组3~4级脑室内出血（intraventricular hemorrhage, IVH）、Ⅱ期及以上早产儿视网膜病变的发生率较低[7.8%（70/892）与12.9%（356/ 2 767），n χ2=16.514；10.0%（89/892）与13.6%（377/2 767），n χ2=8.074]，中重度支气管肺发育不良[7.2%（64/892）与3.8%（105/2 767），n χ2=17.494]、新生儿呼吸窘迫综合征[81.8%（730/892）与72.9%（2 018/2 767），n χ2=28.623]、早发型脓毒症[31.4%（280/892）与27.4%（758/ 2 767），n χ2=5.300]、晚发型脓毒症[16.6%（148/892）与12.4%（344/2 767），n χ2=10.029]、宫外生长发育迟缓[50.2%（448/892）与25.3%（700/2 767），n χ2=191.387]、早发型血小板减少症[10.5%（94/892）与4.6%（126/2 767），n χ2=42.749]、早发型中性粒细胞减少症[16.0%（143/892）与7.6%（210/2 767），n χ2=11.295]、低血糖症[14.2%（127/892）与8.9%（247/2 767），n χ2=20.734]、先天性甲状腺功能减退症[15.7%（140/892）与7.0%（193/2 767），n χ2=62.002]的发生率较高（n P值均<0.05）。（3）多因素logistic回归分析显示，HDP为中重度支气管肺发育不良（n OR=1.695，95%n CI：1.043~2.755，n P=0.033）、新生儿呼吸窘迫综合征（n OR=1.389，95%n CI：1.066~1.809，n P=0.015）、宫外生长发育迟缓（n OR=1.368，95%n CI：1.081~1.731，n P=0.009）、早发型血小板减少症（n OR=1.593，95%n CI：1.054~2.407，n P=0.027）、早发型中性粒细胞减少症（n OR=1.950，95%n CI：1.127~3.375，n P=0.017）、低血糖症（n OR=1.455，95%n CI：1.074~1.970，n P=0.016）及先天性甲状腺功能减退症（n OR=1.799，95%n CI：1.260~2.568，n P=0.001）的独立危险因素，是3~4级IVH的独立保护因素（n OR=0.659，95%n CI：0.461~0.941，n P=0.022）。n 结论:HDP对极早产儿生后多系统功能状态均产生影响，可增加呼吸、血液及内分泌、代谢等系统相关并发症的发生风险，但是重度IVH的保护性因素。“,”Objective:To investigate the effects of hypertensive disorders of pregnancy (HDP) on the mortality and morbidity during hospitalization in very preterm infants born at <32 weeks of gestation.Methods:This prospective, multicenter cohort study recruited 3 659 very preterm infants from 26 comprehensive hospitals and nine maternal and child health care hospitals based on Shandong Neonatal Network from January 1, 2018, to December 31, 2019. According to whether born to mothers with HDP or not, the infants were divided into HDP (n n=892) or non-HDP groups (n n=2 767). Univariate n Chi-square test, n t-test, rank-sum test and multivariate logistic regression analysis were used to assess the effects of HDP on neonatal outcomes.n Results:(1) Among the 3 659 participants, 2 021(55.2%) were male, 434 (11.9%) were extremely preterm infants with <28 gestational weeks, and 433 (11.8%) were extremely low birth weight infants. The incidence of HDP in the cohort was 24.4% (892/3 659). (2) The HDP group had a lower incidence of gradeⅢ/Ⅳ intraventricular hemorrhage (IVH) and retinopathy of prematurity (stage Ⅱ or more severe) compared with the non-HDP group [7.8% (70/892) vs 12.9% (356/2 767), n χ2=16.514, n P<0.001; 10.0% (89/892) vs 13.6% (377/2 767),n χ2=8.074, n P=0.005], but higher incidences of moderate/severe bronchopulmonary dysplasia (BPD) [7.2% (64/892) vs 3.8% (105/2 767), n χ2=17.494], neonatal respiratory distress syndrome (RDS) [81.8% (730/892) vs 72.9% (2 018/2 767), n χ2=28.623] , early-onset sepsis (EOS) [31.4% (280/892) vs 27.4% (758/2 767), n χ2=5.300], late-onset sepsis (LOS) [16.6% (148/892) vs 12.4% (344/2 767), n χ2=10.029], extrauterine growth retardation (EUGR) [50.2% (448/892) vs 25.3% (700/2 767), n χ2=191.387], early-onset thrombocytopenia [10.5% (94/892) vs 4.6% (126/2 767), n χ2=42.749], early-onset neutropenia [16.0% (143/892) vs 7.6% (210/2 767), n χ2=11.295], hypoglycemia [14.2% (127/892) vs 8.9% (247/2 767), n χ2=20.734] and congenital hypothyroidism [15.7% (140/892) vs 7.0% (193/2 767), n χ2=62.002] (all n P<0.05). (3) Logistic regression analysis revealed that HDP was an independent risk factor for moderate/severe BPD (n OR=1.695, 95%n CI: 1.043-2.755, n P=0.033), neonatal RDS (n OR=1.389, 95%n CI: 1.066-1.809, n P=0.015), EUGR (n OR=1.368, 95%n CI: 1.081-1.731, n P=0.009), early-onset thrombocytopenia (n OR=1.593, 95%n CI: 1.054-2.407, n P=0.027), early-onset neutropenia (n OR=1.950, 95%n CI: 1.127-3.375, n P=0.017), hypoglycemia (n OR=1.455, 95%n CI: 1.074-1.970, n P=0.016) and congenital hypothyroidism (n OR=1.799, 95%n CI: 1.260-2.568, n P=0.001), but an independent protective factor for grade Ⅲ/Ⅳ IVH (n OR=0.659, 95%n CI: 0.461-0.941, n P=0.022).n Conclusions:HDP affects functions of various systems in very preterm infants, which may increase the risks of respiratory, blood, endocrine and metabolic complications, but is a protective factor for severe IVH.